NPIMap

Organization Active NPI

Pendleton Manor, Inc

  • Home Health Agency
  • Franklin, WV
National Provider Identifier
1689672115
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PENDLETON MANOR, INC
Practice address
68 Good Samaritan Drive
Franklin, WV 26807-0700
Phone
(304) 358-2320
Fax
(304) 358-3746
NPI assigned
Jul 8, 2005
Organization subpart
Yes
Parent organization
PENDLETON MANOR, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vickie D Bennett, RN, BSN
Title
Director of Home Health
Phone
(304) 358-2320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X WV Primary

Addresses

Primary practice location

68 Good Samaritan Drive
Franklin, WV 26807-0700

Mailing address

68 Good Samaritan Drive
PO Box 700
Franklin, WV 26807-0700
Phone (304) 358-2320

Other identifiers 1

IdentifierTypeStateIssuer
0003817001MedicaidWV

Other names 1

  • PENDLETON HOME HEALTH SERVICES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120405000590 WV Part A Provider - Home Health Agency 2567562473 Practice locations: Franklin, WV

Home health agency certification: CCN 517045

Legal name
PENDLETON MANOR, INC
Doing business as
PENDLETON HOME HEALTH SERVICES
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 2, 1979
Last certification
Feb 26, 2020
Ownership / control type
Proprietary
Organization structure
CorporationNon-profit
Incorporated
Feb 8, 1974 in WV
Enrollment address
75 Saint John Dr
Franklin, WV 26807

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Pendleton Home Health ServicesCCN 517045
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Aug 2, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0901703Pendleton Home Health Services75 Saint John Drive, Franklin, WV 26807Certificate of waiverJun 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pendleton Outpatient Therapy2 organizations share this tax ID, including this one
Part of
Pendleton Outpatient Therapy

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Vickie L Bennett Individual Contracted Managing EmployeeHome Health Director Nov 15, 2020 100%
Cara H Mitchell Individual Corporate Director Dec 17, 2017
Ann Bennett Individual Corporate Director Aug 20, 2021
Marshall Harper Individual Corporate OfficerBoard Member- Treasurer Mar 12, 1984
Cary Hevener Individual Corporate Director Feb 15, 2022
Patricia Sites Individual Corporate Director Aug 20, 2020
Eugene McConnell Individual Corporate Director Mar 21, 2017
Gregory Bowers Individual Corporate OfficerBoard Member- President Jan 1, 2011
Kenneth Harper Individual Corporate DirectorBoard Member Aug 19, 2008
Lynn Vandevander Individual Corporate DirectorBoard Member Feb 19, 2013

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pendleton Manor, IncFranklin, WV, CCN 515124 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 1975
Jan 1, 1975

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689672115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 GOOD SAMARITAN DRIVE",
            "address_2": "PO BOX 700",
            "city": "FRANKLIN",
            "state": "WV",
            "postal_code": "268070700",
            "telephone_number": "304-358-2320",
            "fax_number": "304-358-3746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 GOOD SAMARITAN DRIVE",
            "city": "FRANKLIN",
            "state": "WV",
            "postal_code": "268070700",
            "telephone_number": "304-358-2320",
            "fax_number": "304-358-3746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON MANOR, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENDLETON MANOR, INC",
        "enumeration_date": "2005-07-08",
        "last_updated": "2022-07-21",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF HOME HEALTH",
        "authorized_official_telephone_number": "304-358-2320",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003817001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENDLETON HOME HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PENDLETON HOME HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Franklin, WV

Sources for this page

Verify at the official NPI Registry.